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What to consider when upskilling practice staff

To free-up GP time, NHS England's GP Forward View suggests practice staff could be trained to take on a greater supporting role. The MDU's Dr Sharmala Moodley considers the medico-legal implications of 'upskilling' non-clinicians.

Growing patient demand and fewer GPs have put general practice under increased strain. In response, NHS England has called on practices to give clerical and reception staff additional responsibilities.

The GP Forward View revealed that £45m has been set aside over the next five years so practices can train reception and admin staff for two specific roles: ‘signposting’ patients to the most appropriate healthcare professional and managing clinical correspondence.   

Many non-clinical staff already have an enhanced role within their practice. Administrative staff are commonly involved in dealing with routine correspondence, preparing repeat prescriptions for signature by the GP and managing the review system for patients on long-term medication.

What will staff do?

The purpose of signposting is to advise the patient about the sources of help and advice which are most relevant to their need. It is not to make a diagnosis or plan treatment. It is anticipated that receptionists will offer a choice, not make clinical decisions.

Correspondence management involves clerical staff coding incoming clinical correspondence, taking actions where appropriate, including forwarding it to another member of the team, or passing the letter to a GP for action if a clinical decision is required. It is a more advanced task than document processing or coding alone.

It requires clerical staff to be skilled and confident to make decisions about how to code a letter and its contents in the patient record, how to use an approved protocol for deciding which letters need to be sent to a GP and with what level of urgency, and when to ask for help.

Most practices find that a well-trained administrative team enables them to run more efficiently. But if your practice plans to delegate more tasks to non-clinical staff, there are some medico-legal obligations towards staff and patients to bear in mind.

Training

It is essential that staff are competent and comfortable with taking on additional responsibilities. The GMC expects doctors to 'be satisfied that the staff you supervise have the necessary knowledge, skills and training to carry out their roles'.

In addition, the CQC expects providers to regularly review staff training needs and keep a record of all staff training and development.

NHS England has set out details of training for reception and clerical staff under the GP Forward View on its website. Signposting training, for example, 'should ensure receptionists are confident in communicating available options. Ideally a training experience should include an opportunity for staff to hear from a receptionist 'who is already working in this way.'

It suggests that trained receptionists will need to ‘sensitively’ ascertain the patient’s need and direct them safely and appropriately to sources of advice and support inside or outside the practice.

CCGs will distribute the money set aside by NHS England and help practices determine a suitable training provider. NHS England is producing a directory which will be available on its website.

GP partners remain responsible for the actions of practice staff so it is important that they familiarise themselves with practice training and have a clear understanding of what tasks staff will be trained and competent to carry out. Reputable training providers will set clear objectives, anticipated outcomes and give attendees the opportunity to submit feedback. 

Supervision

When delegating any task to a colleague, GPs are still responsible for the overall care and management of the patient. The GMC's delegation and referral guidance says you must be satisfied that they have 'the knowledge, skills and experience to provide the relevant care or treatment' or that they 'will be adequately supervised'.

It is important to ensure that a senior doctor (GP champion or lead) within the practice has responsibility for overseeing non-clinical staff who take on enhanced roles and that the scheme is properly monitored though regular audits.

There should also be clear procedures to guide clerical staff and ensure consistency. For example, you could provide an action flowchart or a set of red flags for when staff need to get advice from the designated GP or arrange an urgent follow-up appointment. NHS England says that staff who process incoming patient correspondence from hospitals should work to 'standard protocols developed in-house and refined through continuous improvement'.

There should also be a way for staff to raise concerns if they are uncomfortable with a task or they believe a colleague poses a risk to patient safety. Adverse incidents and complaints should be investigated thoroughly with a view to improving systems and training. This work should be subject to regular audit by the GP lead.

Indemnity

All GP partners in a practice are jointly vicariously liable for the acts and omissions of employed practice staff and it is key that any staff undertaking enhanced roles are fully trained, working to up to date protocols and are closely supervised. Staff should have immediate access to clinical guidance and support where needed.

Each medical defence organisation will have their own requirements for indemnity, so it’s important to check what the situation is when upskilling staff. At the MDU, we are happy to advise members about the safe establishment of such systems or their medico-legal implications.

Despite all the above measures being taken, it remains possible that the practice might face a complaint or claim relating to sign-posting or correspondence management by non-clinical staff, for example, if a patient’s treatment was delayed or interrupted because a hospital discharge letter was not properly actioned. If this happens, the GP should approach their medico-legal organisation for help with any claim or complaint.

GPs who provide their services through a limited company (as opposed to a conventional partnership) should be aware that their practice is a distinct legal entity and may itself be sued for failures in the training and supervision of staff. If you are in this position, it is worth checking that your practice has the appropriate corporate indemnity for legal costs and compensation.

  • Dr Moodley is deputy head of underwriting at the MDU

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